A study compares hysterectomies with and without assistance from surgical robots. / Keith Brofsky, Photodisc

by Kim Painter, Special for USA TODAY

by Kim Painter, Special for USA TODAY

Surgical robots are increasingly used for hysterectomies in the United States, even though surgeons using another method can give patients the same results at much lower cost, a new study shows.

The study, published Tuesday in the Journal of the American Medical Association, is the latest to shine light on the rapid adoption of these heavily marketed robots, which also are used in prostate cancer surgery and other operations. Many experts say the robots have yet to prove their worth, but proponents say the rise of the robots is helping patients by drawing surgeons away from traditional techniques that require bigger incisions and have higher risks.

For the new study, researchers looked at the records of 264,758 women who had hysterectomies for non-cancerous conditions such as fibroids, endometriosis or heavy menstrual bleeding, at 441 hospitals between 2007 and 2010. The women had their uteruses removed in one of four ways: through traditional large cuts across the abdomen; through the vagina; through several small incisions, using a hand-held instrument called a laparoscope; or through several small incisions using robot arms a surgeon controls from a nearby console.

Researchers found that use of the robot technique, approved by the Food and Drug Administration in 2005, grew from 0.5% in 2007 to 9.5% by 2010. Hospitals that invested in robot systems (which cost about $1.5 million apiece, according to a recent report in Barron's), used them for 22% of cases within three years.

As use of robots rose, the use of traditional large-incision surgeries fell, says lead author Jason Wright, assistant clinical professor of gynecologic oncology at Columbia University College of Physicians and Surgeons, New York. Those traditional surgeries are known to have higher risks for most women than the other techniques. But, at hospitals with robots, the use of small-incision laparoscopic surgeries done by hand also fell, Wright says.

He and his colleagues looked at outcomes and found immediate complication rates for robotic and laparoscopic surgeries were the same, about 5%. But, largely due to upfront equipment costs, each robot surgery cost nearly $2,200 more - a median of $8,868 vs. $6,679. Though insurers and patients don't directly pay this difference, "we have to weigh the societal benefits," of that health care investment, Wright says.

The money spent on robots might be better spent on training more surgeons in basic laparoscopic techniques, says an accompanying editorial written by researchers from Brigham and Women's Hospital, Boston. While robot surgery has some appropriate uses and may yet prove superior for some hysterectomy patients, right now "we've got two options that give you the same outcome," says editorial co-author Joel Weissman, a health policy expert. "One costs a lot more."

But the nation's surgeons had years to adopt laparoscopic surgery before robots came along and many never did, says Thomas Payne, medical director of the Texas Institute for Robotic Surgery, Austin.

Payne, who is a paid speaker for Intuitive Surgical, the company that makes the robot system used in gynecological surgeries, says surgeons are lining up for robot training because the techniques are easier to learn. "The robot is not better than laparoscopic hysterectomy or vaginal hysterectomy," he says. "It's simply more reproducible." Robot use already is much higher than documented in the study and will only grow, he says.

Robots are "an enabling technology among surgeons," and might speed the adoption of lower-risk surgeries, but "it's an expensive way to get there," says Marty Makary, a surgeon and patient safety researcher at Johns Hopkins Hospital, Baltimore. "We can't just adopt new technology because it's cooler to use. It has to have established benefits for patients."

The widespread adoption of robot surgery before those benefits have been found is a big part of "the story of what's wrong with health care spending in America," he says.